Notification of Changes for Business Entity
General Information
Business Entity Name:	FINANCIAL INSURANCE SERVICES INC
Incorporation / Formation Date:
FEIN:	470791671
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	DOUGLAS
Business Address
Address 1:	5601 N 103RD ST
Address 2:
City:	OMAHA
State:	NE
Zip:	68134
Phone:	4029632361
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	5601 N 103RD ST
Address 2:
City:	OMAHA
State:	NE
Zip:	68134
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	NO	Old Business Entity Name:
New DBA/Trade Name:	NO	New DBA/Trade Name:
Amend DBA/Trade Name:	NO	Old DBA/Trade Name:
Add/Delete Producers, Members, Owners, Partners, Officers and/or Directors:	YES

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
CHANDA HOOKER	AGENT	1066388		YES	11-23-15
CONARD AYBAR	AGENT	1034502		YES	11-23-15
KATHLEEN ADAMS	AGENT	1087907	YES		11-23-15
DAWN BRADNEY	AGENT	1087925	YES		11-23-15
JENNIE GRAYSON	AGENT	1087679	YES		11-23-15
WILLIAM HATCH	AGENT	1087709	YES		11-23-15
MELANIE HEIBERG	AGENT	1087937	YES		11-23-15
DAVID KEEFER	AGENT	1087733	YES		11-23-15
HALEN MILLER	AGENT	1087689	YES		11-23-15
VICTORIA MINOR	AGENT	1087919	YES		11-23-15
KIMBERLY OAKS	AGENT	1087948	YES		11-23-15
JACOB PEARSON	AGENT	1087708	YES		11-23-15
VICTORIA SCARBROUGH	AGENT	1087943	YES		11-23-15
ROBERT THORNBURY	AGENT	1088470	YES		11-23-15
ARISA SPENCER	AGENT	1088484	YES		11-23-15

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date

Title Business Entities Only
1. Is any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance? (i.e. banking, auto dealer, mortgage company)
2. Has any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance since the filing of the previous CN-65 or the original application?
3. If the answer to questions #1 or #2 is yes, identify the business or profession and the nature of person's involvement

Submitted By
Submitted By:	JO WATERS
Title:	LICENSING SPECIALIST
Phone Number:	4029636973
Email Address:	JO.WATERS@SITEL.COM